Anticoagulation management in a pediatric patient with protein S deficiency and acute pulmonary embolism undergoing ECMO-supported intervention: a case report
- 1Department of Intensive Care Medicine, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, Shandong, China
Abstract
Introduction: Protein S deficiency is a predominant form of hereditary thrombophilia in Asian populations. Pediatric venous thromboembolism (VTE) is exceedingly rare, with an incidence of only 0.2%–0.6%, and acute massive pulmonary embolism (PE) requiring extracorporeal membrane oxygenation (ECMO) support in children with thrombophilia presents exceptional clinical challenges. The core therapeutic dilemma lies in reconciling the hypercoagulable state inherent to protein S deficiency with the high bleeding risk following thrombolytic therapy, compounded by the obligatory anticoagulation requirement during ECMO. This case report describes the nursing management of a pediatric patient with protein S deficiency and acute PE who successfully underwent ECMO-supported interventional treatment under high bleeding risk.
Outcome: The patient was successfully weaned from ECMO after 98 h of support, extubated on day 6, and discharged in stable condition after 30 days of hospitalization. At 6-month follow-up, no thrombus recurrence was observed, and the patient had fully resumed normal life and academic activities.
Conclusion: This case demonstrates that an individualized low-dose heparin anticoagulation strategy, guided by the PEACE consensus and supported by meticulous monitoring, can effectively balance the competing risks of thrombosis and hemorrhage in pediatric ECMO patients with underlying thrombophilia and recent thrombolysis. Notably, as a single case report, this finding cannot be broadly generalized to all pediatric ECMO patients with thrombophilia. Instead, this case provides a potential framework for individualized anticoagulation and nursing management that requires further validation in larger pediatric cohorts. The nursing experience provides a practical reference for managing similar complex cases in pediatric critical care.
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BibTeX
@article{geng2026anticoagulation,
title = {{Anticoagulation management in a pediatric patient with protein S deficiency and acute pulmonary embolism undergoing ECMO-supported intervention: a case report}},
author = {Chen Geng and Miao Zhang},
journal = {Frontiers in Pediatrics},
year = {2026},
month = oct,
doi = {10.3389/fped.2026.1956558},
url = {https://doi.org/10.3389/fped.2026.1956558},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Anticoagulation management in a pediatric patient with protein S deficiency and acute pulmonary embolism undergoing ECMO-supported intervention: a case report
AU - Chen Geng
AU - Miao Zhang
PY - 2026
DA - 2026/10/22
JO - Frontiers in Pediatrics
DO - 10.3389/fped.2026.1956558
UR - https://doi.org/10.3389/fped.2026.1956558
AB - Introduction: Protein S deficiency is a predominant form of hereditary thrombophilia in Asian populations. Pediatric venous thromboembolism (VTE) is exceedingly rare, with an incidence of only 0.2%–0.6%, and acute massive pulmonary embolism (PE) requiring extracorporeal membrane oxygenation (ECMO) support in children with thrombophilia presents exceptional clinical challenges. The core therapeutic dilemma lies in reconciling the hypercoagulable state inherent to protein S deficiency with the high bleeding risk following thrombolytic therapy, compounded by the obligatory anticoagulation requirement during ECMO. This case report describes the nursing management of a pediatric patient with protein S deficiency and acute PE who successfully underwent ECMO-supported interventional treatment under high bleeding risk. Outcome: The patient was successfully weaned from ECMO after 98 h of support, extubated on day 6, and discharged in stable condition after 30 days of hospitalization. At 6-month follow-up, no thrombus recurrence was observed, and the patient had fully resumed normal life and academic activities. Conclusion: This case demonstrates that an individualized low-dose heparin anticoagulation strategy, guided by the PEACE consensus and supported by meticulous monitoring, can effectively balance the competing risks of thrombosis and hemorrhage in pediatric ECMO patients with underlying thrombophilia and recent thrombolysis. Notably, as a single case report, this finding cannot be broadly generalized to all pediatric ECMO patients with thrombophilia. Instead, this case provides a potential framework for individualized anticoagulation and nursing management that requires further validation in larger pediatric cohorts. The nursing experience provides a practical reference for managing similar complex cases in pediatric critical care.
SN - 2296-2360
ER -